MDO PERIODONTICS PA (NPI# 1558516369) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558516369 |
| Entity Type | Organization |
| Organization Name | MDO PERIODONTICS PA |
| Practice Address |
1900 Kruchten Ct S Ste. 101 Sartell MN 56377-4730 |
| Practice Telephone | 3202409028 |
| Practice Fax Number | 3202409048 |
| Mailing Telephone | 3202409028 |
| Mailing Fax Number | 3202409048 |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2008-11-20 |
| Authorized Official Name | MICHELLE GRUNDHOEFER (OFFICE MANAGER) |
| Authorized Official Telephone | 3202409028 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers |
| Street Address |
1900 KRUCHTEN CT S STE. 101 |
| City | SARTELL |
| State | MN |
| Zip Code | 56377-4730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376785501 | Central Minnesota Endodontics, Pa | Dentist | 1900 Kruchten Ct S, Suite 100, Sartell, MN 56377-4730 | 2009-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235783515 | Chae Norman | Massage Therapist | 303 4th Ave S, Suite C, Sartell, MN 56377 | 2019-07-25 |
| 1497317259 | Stephanie Maria Schaefer | Behavioral Analyst | 1133 Mockingbird Loop, Sartell, MN 56377 | 2019-07-02 |
| 1538722848 | Madison Toughill | Behavior Technician | 205 14th Ave E, Sartell, MN 56377 | 2019-04-22 |
| 1902388671 | Julie Ann Helms | Counselor | 101 Dehler Dr., Sartell, MN 56377 | 2018-08-30 |
| 1104337617 | Louis Chester Winskowski IIi | Orthotist | 50 14th Ave E Suite 114, Sartell, MN 56377 | 2017-10-24 |
| 1962958611 | Centracare Clinic | Exclusive Provider Organization | 166 19th Street S, Suite 202, Sartell, MN 56377 | 2016-08-31 |
| 1295197846 | Mindful Healing & Training | Counselor | 1417 15th Street South, Sartell, MN 56377 | 2016-03-23 |
| 1710342894 | Saint Cloud Hospital St. Benedict's Senior Community | Skilled Nursing Facility | 990 19th St. S., Sartell, MN 56377 | 2015-12-16 |
| 1932452661 | David Peter Pogatchnik | Pharmacist | 2251 Connecticut Ave. South, Health Partners Central Minnesota Clinics (pharmacy), Sartell, MN 56377 | 2012-10-18 |
| 1669759866 | Lakewood Health System | Clinic/Center | 161 19th St S Ste 106, Sartell, MN 56377 | 2011-11-16 |
| Find all providers in zip 56377 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316400591 | Shorouk Elnagdy | Dentist | 515 Delaware St Se # 7-368, Minneapolis, MN 55455-0357 | 2019-04-13 |
| 1508300252 | Minnesota Periodontal Associates, Pa | Dentist | 4801 Hwy 61 N., Suite 300, White Bear Lake, MN 55110-2753 | 2016-12-15 |
| 1164978672 | Benjamin Halpern | Dentist | 14344 Burnhaven Drive, Burnsville, MN 55306 | 2016-08-26 |
| 1356684419 | Shahir Nehad Abdel-malek | Dentist | 3555 Louisiana Ave S, Saint Louis Park, MN 55426-4121 | 2013-03-27 |
| 1386901858 | Jeanne L Barss | Dentist | 2550 University Ave W Ste 189s, Saint Paul, MN 55114-2001 | 2012-04-20 |
| 1205129012 | Jerod Thomas Klava | Dentist | 6545 France Ave. So., Suite 190, Edina, MN 55435 | 2011-05-26 |
| 1861784050 | Elham Akhlaghi | Dentist | 515 Delaware Street, Minneapolis, MN 55455 | 2011-05-06 |
| 1013216811 | Minneapolis-st. Paul Periodontics | Dentist | 1109 East Moore Lake Drive, Fridley, MN 55432 | 2011-03-18 |
| 1972770006 | Ying-lien Wu | Dentist | 150 S 5th St Ste 1475, Minneapolis, MN 55402-4212 | 2008-05-08 |
| 1760657795 | Steven Robert Jacobsen | Dentist | 4801 Hwy 61, #300, White Bear Lake, MN 55110 | 2008-04-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.